Laserfiche WebLink
CONTAINER CONSTRUCTION STATE ID NUMBER 00000009554002 <br /> E. ( 1 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING ( ) 04 PHENOLIC LINING ( ] 05 GLASS LINING <br /> IX1 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER: <br /> F• ( 1 <br /> 01 POLYETHLENE WRAP ( ) 02 VINYL WRAPPING ( 1 03 CATHODIC PROTECTION ( ) 04 UNKNOWN (X) OS NONE <br /> ( ) 06 TAR OR ASPHALT f ] 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE-WALLED PIPE f 1 02 CONCRETE-LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( 1 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: f ) 01 DOUBLE-WALLED PIPE ( ) 02 CONCRETE-LINED TRENCH f ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ] 04 PRESSURE (X) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> VII LEAK DETECTION <br /> (X). 01 VISUAL fX) 02 STOCK INVENTORY ( 1 04 VAPOR SNIFF WELLS f ) 05 SENSOR INSTRUMENT <br /> (X) 06 GROUND WATER MONITORING WELLS ( 1 07 PRESSURE TEST ( ) 09 NONE (X) 10 OTHER: GOVT. INSPECTS FUEL <br /> VIII CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> IF YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> CURRENTLY PREVIOUSLY DELETE CAS# (IF KNOWN) <br /> STORED STOPED CHEMICAL (00 NOT USE COMMERCIAL NAME) <br /> ) 01 f ) 02 ( ) 03 <br /> ( 1 01 ( ) 02 ( ) 03 - <br /> f 1 01 f ) 02 ( ) 03 <br /> ( ) 01 ( 1 02 f ) 03 <br /> ( ) 01 ( ) 02 ( ) 03 <br /> ( 1 01 f ) 02 ( ) 03 <br /> l ) 01 ( ) 02 ( ) 03 <br /> ( 1 <br /> 01 ( ) 02 [ ) 03 <br /> ( 1 01 ( l 02 ( ) 03 <br /> ( L O1 [ ) 02 ( 1 03 <br /> * CHECK STATE BOARD CHEMICAL CODE LISTING FOR POSSIBLE SYNONYMS <br /> IS CONTAINER LOCATED ON AN AGRICULTURAL FARM? ( ) 01 YES (X) 02 NO <br /> THIS FORM HAS BEEN COMPLETED UNDER THE PENALTY OF P/ JURY AND, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. <br /> PERSON FI (SIGNATURE) C <br /> PHONE W/APER CODE <br /> FOR LOCAL AGENCY USE ONLY <br /> ADMINISTRATING AGENCY <br /> �/ u 1 L� t)15T CITY CODE <br /> N cA L 1. elA- cT COUNTY CODE <br /> CONTACT <br /> ����PERSON <br /> TC <br /> N141j SVP'( tlVe,-4/4W 0 PHONE W/AREA CODE <br /> DATE OR LAST INSPECTION IN COMPANCE <br /> ( / O1 LIYES ( ) 02 NO PERMIT APPROVAL DATE TRANSACTION DATE LOCAL PERMIT ID k <br /> SC04-070185 (10/18/85) <br /> PAGE 2 <br />